OBJECTIVE
Certain medical devices such as neurostimulators may be implanted during an inpatient procedure. Medicare covers the initial implantation and replacements or revisions to the device. Hospitals must meet Federal requirements for neurostimulator implantation surgeries to be covered by Medicare. Prior OIG audit work determined that Medicare made improper payments to hospitals for outpatient claims for neurostimulator implantation surgeries. Currently, CMS requires prior authorization for outpatient neurostimulator implantation surgeries, but not for inpatient neurostimulator implantation surgeries. Prior authorization helps CMS ensure that applicable requirements are met before the services are provided. CMS’s lack of prior authorization for inpatient neurostimulator implantation surgeries may leave this area vulnerable to potential improper payments. We will determine whether CMS made Medicare payments to hospitals for inpatient neurostimulator implantation surgeries in accordance with Federal requirements.
TIMELINE
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March 16, 2026Announced
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TodayOffice of Audit Services In-Progress
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Est FY2028Estimated Fiscal Year for Project Completion